Adjustment Disorders in Children

________________________________________________________________________

KEY POINTS

• An adjustment disorder is a way of reacting to stress that lasts less than 6 months.
• Symptoms of an adjustment disorder may involve depression, anxiety or problems with behavior.
• Treatment may include therapy, learning ways to manage stress, and sometimes medicines.

________________________________________________________________________

What is an adjustment disorder?

An adjustment disorder is a reaction to stress that lasts less than 6 months after the stressful event. The stress may be a change in the family, such as a move, divorce, birth, or death of a pet. It may be a very stressful event such as abuse, tornado, rape, severe car accident, or a national tragedy. If a child has an adjustment disorder, the child's reaction seems to be out of proportion to what happened and gets in the way of daily activities.

What is the cause?

It is not known why one child develops an adjustment disorder while another does not. Adjustment disorders are not thought to be caused by anything physical. Children and teens vary in their temperament, past experiences, vulnerability, and coping skills. Their maturity and support system also have something to do with how they react. Abuse or neglect in early childhood increase the risk. Stressors also vary in how severe the experience is, whether it happens again, and how parents react to the event.

What are the symptoms?

Your child may:

• Cry easily and seem sad
• Be very irritable or have angry outbursts
• Destroy property or get in fights
• Fear being separated from parents
• Have physical symptoms such as headaches or stomachaches
• Have trouble concentrating and perform poorly in school
• Have trouble falling or staying asleep, or have nightmares
• Have changes in appetite
• Lose interest in activities he or she once enjoyed
• Show sudden and extreme emotional reactions such as anxiety, panic, anger, or guilt
• Worry all the time, seem nervous, and startle easily.

How is it diagnosed?

If your child's symptoms last for more than 3 months after the event and interfere with daily life, see your child's healthcare provider. Your child's healthcare provider will ask about the child's symptoms, medical and family history, and any medicines the child is taking. Your child may have some lab tests to rule out medical problems such as chemical imbalances. If your child's symptoms do not have a physical cause, you may be referred to a mental health specialist. The mental health specialist will ask about your child's development, emotions, behaviors, and the stressful event.

How is it treated?

Treatment is based on your child's age, overall health, medical history, and symptoms. Therapy (individual, group, or family) may help reduce fears and worries. Cognitive behavioral therapy (CBT) is very helpful for adjustment disorders. Art and play therapy can also help young children draw pictures about what happened or play out their feelings. Support groups can help your child understand that he or she is not alone. Groups also provide a safe place to share feelings.

A mental health specialist might also recommend medicines. These medicines can help reduce depression and anxiety and help your child cope with school and other daily activities. Medicine is often used as a temporary measure to help until your child feels better.

What can I do to help my child?

• Let your child talk about the stressful event or change when and if he or she feels ready. Be a good listener. Do not force the issue if your child does not feel like sharing her thoughts. If your child shuts you out, don't walk away. Let children know that you are there for them whenever they need you. Remind children of this over and over again.
• Reassure your child that his or her feelings are okay and that he or she is not "going crazy." The support and understanding that you provide can help your child accept frightening emotions.
• Stay in touch with teachers, babysitters, and other people who care for your child to share information about symptoms your child may be having.
• Be consistent. Understand that you are not responsible for your child's symptoms, even if something such as a divorce may have triggered it. Be firm and consistent with rules and consequences. Your child needs to know that the rules still apply to them. It does not help to teach children that they can avoid consequences even when they’re hurting.
• Let your child make simple decisions when appropriate. Because stress often makes a child feel powerless, you can help children by showing them that they have control over certain parts of life. For example, you might consider letting your child decide what to have for dinner or how to spend the day.
• Take care of your child’s physical health. Make sure your child eats a healthy diet and gets enough sleep and exercise every day. Teach children and teens to avoid alcohol, caffeine, nicotine, and drugs.
• Check your child’s medicines. To help prevent problems, tell your healthcare provider and pharmacist about all of the medicines, natural remedies, vitamins, and other supplements that your child takes. Talk to your provider if your child has problems taking the medicine or if the medicines don't seem to be working.
• Get emergency care if your child has serious thoughts of suicide or self-harm, violence, or harming others
• Take care of yourself so that you are well equipped to help your child. You can't be supportive if you're neglecting your own emotional or physical health.